Week #2 (Nerymar Ortiz Otero): Having Fun with the Brain Staff at the First Time!

          I work with Dr. Theodore Schwartz in the Spine and Neurology field. He is specialized in the surgical procedure to treat brain tumor, pituitary tumor and epilepsy with the latest generated approaches. During my second week in the immersion program, I spent the same time in clinic and in the OR. In the clinic, we saw to many patients, analyzed their MRI scans and PET scans to find the correct diagnose. This experience was really useful because I could learn how attend to the patients, to read and get significant information from their scans, medical history and their conversation to make the best decision about them. However, in the OR the experience was completely different in comparison with the clinic but really useful like it. In the OR, I observed four surgeries where the scope was the following: correct a skull defect, resection of pituitary adenomas and meningioma.

          Basing in the cases observed in the clinic and in OR, the most interesting case was a male that came to the center with a leak through nose. Sixteen years ago he had a big trauma in his face and brain caused by an accident. On Tuesday he came to the clinic with symptoms, such as: a significant leak by nose when he moved his head toward down and some seizures. His MRI scan showed a defect that consists in a hole localized in the top part of the nose. This hole allowed that the cerebrospinal fluid came out by nose. Dr. Schwartz recommended that the best shot for him as a surgery to close the defect and avoid the leak. The only option to make the surgery is through a craniotomy because via nose (endoscopic approach) is not appropriated to reach the defect.

          On the next day, the patient got the surgery to fix the defect. The surgery was a craniotomy that consisted in make a large incision in the part where is the frontal lobe. The incision was approximately 7 inches. After it, the Dr. Schwartz folded back the skin flap until reach a point more close to the defect. At that moment, he opened the skull without access to the brain because in there is only muscle until the nose. He removed some muscle and, using the 3D MRI, he could find the hole. To fix the defect, he put a fat flap over it to close using sutures. To close the craniotomy, he put a fat flap to replace the muscle removed and put the bone flap back secured using titanium plates and screws. At the end, he put a soft dressing (Ex. Polymer) over the incision. The most interesting part in this surgery was how the Dr. Schwartz could find the defect using the MRI to guide himself. This was not easy find the hole but he could do that.

          On my first week, I had a lot of chance to learn new knowledge from the MRI scans. Also, how the people in the OR prepare the patient that is going to have a neurosurgery. This was my first time seeing and learning concepts related to the brain and I am really excited with that. Here I presented the most interesting part of the whole week. Hopefully, over time I will have more interesting case where I can learn a lot about them.